Breast Patient Navigation Program Hopes To Reduce Disparities Among Hispanic/Latina Women

Having identified healthcare disparities reflected in the incidence of morbidity and mortality of breast cancer among Hispanic/Latina women (HLW), a team of nurses, Gina Miranda-Diaz, MSN, MPH, RN-CBPN-I; Magaly Fernandez-Ghander, BSN, MBA, RN; and Ivette Cora-Gonzalez, MSN, RN, conducted an assessment of breast healthcare disparities in Union City, New Jersey. As a result of those findings, Miranda-Diaz has initiated a navigation program for this population. The program seeks to increase screening rates among HLW, with the goal of reducing mortality through early diagnosis.

THE PROBLEM

“In the United States, we still have a problem with cultural disparities in healthcare—no political voice, inability to speak the language, no access, and healthcare workers who do not speak their language. Among the top 5 reasons are fear, inability to understand healthcare workers, and not having insurance,” Miranda-Diaz told the Journal of Oncology Navigation & Survivorship. When she and her team examined breast cancer disparities among HLW, what they found was disturbing.

• Breast cancer is the primary cause of cancer death among HLW in the United States, according to the American Cancer Society.
• Breast cancer is the leading cancer health disparity among HLW in the nation, according to the New Jersey Behavioral Risk Factor Survey.
• HLW have lower rates of getting recommended screening mammograms than white and black women, according to the United States Department of Health and Human Services and the National Institutes of Health.
• Screening rates for white and black women are slightly below the Healthy New Jersey 2010 target of 75%, with HLW lagging behind, according to the New Jersey Behavioral Risk Factor Survey.
• The age-adjusted breast cancer incidence rate for black and Hispanic women is 20% to 30% below that of white women, according to the Center for Health Statistics.
• A higher percentage of breast cancers are diagnosed at an early (in situ/local) stage for white women than among blacks and HLW, according to the Department of Health and Human Services Office of Minority and Multicultural Health.
• Although HLW have lower incidence rates for breast cancer than white non-Hispanic women; HLW who develop breast cancer are more likely to die from the disease, according to the National Cancer Institute.

These data are particularly relevant in Union City because of the community’s demographics. Union City is comprised of 76.4% Hispanics or Latinos, 18.9% whites, 3.0% blacks or African Americans, 1.3% Asians, and 0.4% other races, according to a 2008 survey by the United States Census Bureau. The category of Hispanic or Latino was broken down into 7.3% Mexican, 8.8% Puerto Rican, 12.5% Cuban, and 47.8% other Hispanic or Latino. In addition, of individuals older than 5 years of age in Union City, 86% speak a language other than English at home, with 94% speaking Spanish, and 6% other lan-guages. Fifty-five percent believe they do not speak English very well.

Economic disparity was found too. According to city records, 65% of residents have a high school degree or higher compared with 85% of the US population. Thirty-five percent of residents have less than a high school diploma. Only 17.7% of residents hold a bachelor’s degree or higher compared with the national average of 27.4%. The per capita income in Union City is $18,487 compared with $34,899 for the state of New Jersey and $27,466 at the national level. An estimated 15.9% of families and 19.1% of individuals fall below the poverty level in Union City.

THE SOLUTION

To address disparities, the Union City Breast Patient Navigator Program (UC-BPaN) provides a breast healthcare navigator to liaison with community health providers, diagnostic radiology centers, local and state politicians, community-based healthcare providers such as the North Hudson Community Action Corporation, local community- based organizations that contribute funding and culturally-centric information to the community, the organization Save Latin America, and the Union City Board of Education.

UC-BPaN is based on the lay navigation model, because Miranda-Diaz believes it offers the best outreach potential. The navigators will not be foreign to the healthcare system, though. Miranda- Diaz, who is bilingual English/Spanish, acts as the nurse and go-to person for the navigators. A bilingual mammogram tech also navigates patients. Three additional navigators, also bilingual, work as medical assistants. A few were nurses in Cuba, but are not licensed in New Jersey as such. Their employment as medical assistants offers the opportunity for them to navigate patients at the doctors’ offices and send study information to Miranda- Diaz through an Internet-based database.

With the main goal of increasing screening rates among HLW, Miranda-Diaz teaches classes at the community-based organization Save Latin America and attends health fairs with her team of lay navigators. They not only raise awareness and provide breast health education, but also enter people into the navigation program at these events. After a woman’s information in entered into the database, one of the navigators follows up with her, reminding and encouraging her to get a mammogram. If a screening indicates a need for further action or includes a cancer diagnosis, she will be navigated through the entire course of treatment.

The team also plans parties similar to Tupper - ware parties with breast cancer bingo, and visits women in their homes and churches. With HLW, Miranda-Diaz says, going into churches works well because of the religious commonality among most HLW. They are mostly Christian churches, and in Union City there are at least half a dozen in a square block area.

As one of less than 1% of Latinas who is doctorally prepared, Miranda-Diaz hopes this project can, through outreach, save women’s lives in her community.

UNION CITY BREAST PATIENT NAVIGATOR PROGRAM GOALS

SHORT-RANGE GOALS

1. Bilingual breast healthcare navigators: certified registered nurses who implement and oversee programs.
2. Laypersons: recruit and train women to become patient navigators in breast health committed to sharing experience and knowledge with their peers.
3. Patient navigators: conduct marketing and communication regarding the Union City Breast Health Initiative to healthcare agencies, communitybased organizations, local and state governments.

LONG-RANGE GOALS

1. Improve early mammography screening; reduce breast cancer health disparity in Union City, NJ. Offer program statewide.
2. Create teams of lay patient navigators who will provide outreach to the women of Union City, NJ.
3. Marketing Union City Breast Health Initiative to radiology centers, providers, and local (Board of Education) and state agencies (New Jersey Cancer Education and Early Detection Program).

Disclosure
This article contains information prepared by the study’s principal investigator, Gina Miranda-Diaz, MSN, MPH, RN-CBPNI, in preparation for the navigation program, which began May 1, 2011. Both Magaly Fernandez- Ghander, BSN, MBA, RN, and Ivette Cora- Gonzalez, MSN, RN, contributed to the initial background assessment. All 3 nurses are enrolled in the Doctorate of Nursing Practice program at the University of Medicine and Dentistry in Newark, New Jersey.